This proposal is a substantial revision of application 1 R21 MH079984-01 which was reviewed October 11, 2006 by the Mental Health Services in Non- Specialty Settings review group. Goals, specific aims, and hypotheses have been clarified to be consistent with a study of the equivalence between outcomes of known child psychiatric treatments for ADHD delivered via telepsychiatry as compared with face-to-face treatment. To address the concerns about small sample size and distribution of cases between ADHD and depression, the revised study will include only youths with ADHD. The revised study also makes use of qualitative analysis methods to address other important issues of equivalence concerning acceptability and burden of the technology. The assessment batteries have been simplified to reduce respondent burden. The research team has been strengthened by increasing the percent effort of the PI and the co-investigator and the latter's role will involve regular oversight of the project. An expert in qualitative analysis, Carla Green, PhD, MPH, has been added as a research consultant. The motivation for the project is to establish feasibility of a larger multi- state randomized controlled study that would demonstrate equivalent outcomes for telepsychiatry and face-to-face treatment of ADHD in rural youth. This research will strengthen the evidence base on outcomes of telepsychiatry in children, which is needed to justify large scale investment in telepsychiatry as a means of improving rural youths'access to specialty child psychiatry services. The proposed subsequent multi-state study has been described in greater detail.